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Cardiac MR to determine culprit lesion 3 years after LCx stenting

Case Study
Yun, Chun-Ho, M.D. Mackay Memorial Hospital • Taiwan
Tsai, Cheng-Ting, M.D. Mackay Memorial Hospital • Taiwan
Yang, Fei-Shih, M.D. Mackay Memorial Hospital • Taiwan

Patient history

A 60-year-old male had PCI for LCx stenting 3 years ago. His risk factors are hypertension and hyperlipidemia. This patient with stable angina for a few weeks underwent Cardiac MR stress testing at Mackay Memorial Hospital.

MR examination

Achieva 3.0T with the 32-channel SENSE cardiac coil was used.
With persantine as a stressor, stress/rest perfusion was performed. Cine imaging of 2-chamber, 4-chamber and SAX is done, as well as delayed enhancement.
Multihance contrast medium was administered.
Total scan time was around 35 minutes.


 Stress Negative DLE
Negative DLE
At stress perfusion, a perfusion defect is present at the anterior wall. There is no MR evidence of non-viable myocardium at delayed enhancement.

LCX  QCA: 77% LAD  QCA:55% RCA  QCA: 55%
LCX QCA: 77%
RCA QCA: 55%
Coronary angiography showed triple vessel disease. It means mismatch of MRI and angiography.

LCX  FFR: 0.88 LAD  FFR: 0.63 RCA  FFR: 0.86
LCX FFR: 0.88
LAD FFR: 0.63
RCA FFR: 0.86

FFR result revealed only LAD lesion is the flow-limiting lesion which compatible with stress MR finding.


CMR findings are stress-inducible ischemia at the anterior wall of the left ventricle, suggestive of a flow limiting lesion at LAD.
Coronary angiography: LAD-p:55%, RCA-p:55%, LCx-m:77%

FFR: LAD: 0.63, RCA: 0.86, LCx: 0.88

Clinical impact of Cardiac MR stress testing

In this case, the MR result is not consistent with coronary angiography. Based on per-patient analysis, CMR has did a good job. But in per-vessel analysis, CMR cannot provide an accurate diagnosis of RCA and LCx. However, as we know, a high grade stenosis is not equal to a flow limiting lesion. Fractional flow reserve in this case demonstrates that only the LAD lesion has FFR<0.8, supporting the CMR finding. With CMR, we can provide the functional information to interventional cardiologists before the invasive angiography.

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Jun 5, 2012

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Case Study
Achieva 3.0T
32ch SENSE Cardiac coil, Cardiac, Cardiac function, CMR, Ischemia, stenosis, stress test

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